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INDIANA SHORTAGE
DESIGNATIONSRaymond J. Guest, M.P.H.
Primary Care Office Manager
Indiana State Department of Health
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Definitions
PCO PCA OSD HRSA NHSC CMS
National Health Service Corps
Centers for Medicare & Medicaid Services
Health Resources & Services Administration
Primary Care Office (ISDH)
Primary Care Association (IPHCA)
Agencies
Office of Shortage Designation
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Definitions
HPSA
MUA
MUP
Health Professional Shortage Area
Medically Underserved Area
Medically Underserved Population
Types of Designations
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NHSC SLRP FQHC Program
CMS Medicare Incentive
Payment Program
CMS Rural Health Clinic
Program
J-1 Visa Waiver
Program
Primary Care HPSA X X
Geographic
onlyX X
Dental HPSA X X
Mental HPSA
X X
Geographic
only,
ask CMS
X
HPSA Subtypes
Geographic HPSA X X X X X
Population HPSA X X X X
Facility HPSA X X X
MUA X X X
MUP X X
Governor’s Exception MUP
X X
Designations Needed for Selected Federal Programs
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Application Process
Determine Rational Service Area (RSA)
Determine Contiguous Service Areas
Identify providers (Local Help Needed)
Collect data.
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Application Process
Determine Rational Service Area (RSA)
Single County
Multi-county or Catchment Area
Partial County
Census Tracts
Townships
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Application Process
Facility Designations HPSA Designation of Facilities Prisons Medical Facilities (i.e. Community Health Centers)
Automatic HPSA Designation of Facilities Federally Qualified Health Centers (FQHC) Rural Health Centers (RHC)
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Application ProcessDesignation of a geographic area or population?
Geographic areaPopulation
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Application ProcessDesignation of a geographic area or population?
Populations that can be designated:Low-income/poor
Migrant farm workers
Homeless
Medicaid eligible
et al.
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Application Process
Preliminary Analysis Determine Contiguous Service Areas
20 mile polygon for Primary Care HPSAs
25 mile polygon for Dental & Mental HPSAs
No contiguous analysis for MUA/Ps
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Application ProcessIdentify Providers
Primary Care Physicians
Family/General Practice
General Internal Medicine
General Pediatric Medicine
OB/GYN
Geriatric Medicine
Immediate care physicians
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Application Process
Identify Providers
Dentists who provide direct patient care
General Dentistry
Pediatric Dentistry
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Application Process
Identify Providers
Core Mental Health Providers (CMHP)
Psychiatrists
Clinical Psychologists
Clinical Social Workers
Psychiatric Nurse Specialists
Marriage and Family Therapists
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Application Process
Collect demographic data
Race
Poverty
Infant Mortality Rate
Age (65+)
Low-Income
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Application Process
Survey providers
In RSA
In Contiguous Service Areas
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Application Process
Analysis
Are all the qualifications met?
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Application Process
Analysis - Qualifications for RSAs PC-HPSA – Geographic
3500:1 pop to provider ratio PC-HPSA – Population
3000:1 pop to provider ratio 30% of population must be at or below 200% of
poverty
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Application Process
Analysis - Qualifications for RSAs Dent-HPSA – Geographic
5000:1 pop to provider ratio Dent-HPSA – Population
4000:1 pop to provider ratio 30% of population must be at or below 200% of
poverty
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Application Process
Analysis - Qualifications for RSAs
Ment-HPSA Geographic 30,000:1 psychiatrists only 9,000:1 CMHP including psychiatrists 6,000:1 CMHP and = or > 20,000:1 psychiatrists
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Application Process
Analysis – Qualifications for RSAs Ment-HPSA Population
20,000:1 psychiatrists only 6,000:1 CMHP including psychiatrists 4,500:1 CMHP and > 15,000:1 psychiatrists 30% of population must be at or below 200% of
poverty
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Application Process
Analysis - Qualifications for Contiguous Areas Barriers to access
Distance Physical barriers Socio-Economic disparities Contig Area has = or > designation Self Identified neighborhood Overutilization
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Application Process
Analysis – Qualifications for Contiguous Areas For Primary Care HPSAs,
no resources within 30 min For Dental & Mental HPSA’s
no resources within 40 min.
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Application Process
Analysis - Qualifications for Contiguous Areas Overutilization Population to provider ratios
PC > 2,000:1 Dent > 3,000:1 Ment > 20,000:1 (psychiatrists) or Ment > 3,000:1 (CMHP) + >10,000:1 (psychiatrists)
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Application Process
Analysis – Qualifications for MUA/Ps MUA & MUP– Score of 62 or less
Variables % of Population in Poverty % of Population 65 & over Infant Mortality Rate Providers per 1000 population
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Medically Underserved Area (MUA)
Variable Value WV
V1. Poverty 10.5% 20.0
V2. >65 pop 12.2% 19.1
V3. IMR 13.1 21.5
V4. Prov/1000 pop .151 .5
Total Score 61.1
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Application Process
Review Identify RSA & Contig Areas Identify providers Survey providers Analysis Submission to OSD Designation
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Resources
ISDH web site
http://www.in.gov/isdh/publications/llo/shortages/shortage.htm
Official Designation Database
http://hpsafind.hrsa.gov/
Nat’l Health Service Corps
http://nhsc.bhpr.hrsa.gov
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ContactNatalie Brown, MPH
Shortage Designations and National Health Service Corps Program
Director
Indiana Primary Health Care Assoc.
(317) 630-0845
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ContactRaymond J. Guest, MPHPrimary Care Office Manager
Indiana State Department of Health
(317) 233-7846
